Influencing factors of survival after antiviral therapy in 1984 HIV/AIDS patients and the construction of nomogram prediction model
Objective To analyze the influencing factors of the survival of HIV/AIDS patients after receiving antiviral therapy in Rongchang District of Chongqing,and a nomogram prediction model was constructed to predict their mortality risk,so as to provide reference for the identification and intervention of high risk groups with treatment prognosis.Methods A total of 1 984 HIV/AIDS patients aged≥15 years who received antiretroviral therapy for the first time in Rongchang District,Chongqing,China in 2005-2022 were selected,the differences in survival time of different groups were compared by using the Log-Rank test in Kaplan-Meier,the independent risk factors for death were screened out by multivariate Cox regression analysis to construct a nomogram model.Results Multivariate Cox regression analysis showed that the risk of death in the male group was 1.915 times higher than that in the female group(95％CI:1.142-3.211,P=0.014).At the beginning of treatment,the risk of death in the ≥ 50-year-old group was 2.185 times higher than that in the＜50-year-old group(95％CI:1.367-3.493,P=0.001),the mortality risk of injecting drug abuse was 2.834 times higher than that of heterosexual transmission(95％CI:1.395-5.755,P=0.004),the mortality risk in the passive detection group was 1.909 times that of the active detection group(95％CI:1.009-3.613,P=0.047).In terms of the interval between diagnosis and treatment,the risk of death in the ≥1-month group was 1.683 times higher than that in the＜1-month group(95％CI:1.063-2.667,P=0.027),and the risk of death in baseline CD4+T cell count＜200 cells/μl was 4.163 times higher than that of ≥200 cells/μl(95％CI:2.569-6.746,P＜0.001),In the initial treatment regimen,the risk of death in the nevirapine-containing group was 1.806 times higher than that in the efavirenz-containing group(95％CI:1.124-2.903,P=0.015),and the mortality risk of the lopinavir and ritonavir-containing group was 3.293 times higher than that of the efavirenz-containing group(95％CI:1.727-6.280,P＜0.001),and the mortality risk in the missed drug group was 2.333 times higher than that in the non-missed drug group(1.474-3.693,P＜0.001).The C-index of the nomogram prediction model was 0.797(95％CI:0.753-0.841),and the area under the curve of 5-year and 10-year death prediction was 0.786 and 0.663,respectively.The calibration curves for the 5-year and 10-year survival rates closely matched the standard curve.When predicting the 5-year survival rate,the threshold probability ranged from 0.04 to 0.42,and for predicting the 10-year survival rate,the threshold probability ranged from 0.05 to 0.75,indicating a higher clinical benefit rate for the prediction model.Conclusion The preliminarily constructed nomogram model has good prediction ability,which can provide reference value for accurate early identification and early intervention of high risk groups with treatment prognosis.
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